The Royal Australian College of General Practitioners (RACGP) has welcomed the findings of an independent review of Medicare non-compliance and urged the federal Government to provide greater support for general practice care in the upcoming May Budget.
It comes following Dr Pradeep Philip's long-awaited independent report into claims of Medicare rorting made by the 7.30 and Nine papers joint "investigation" last year. His review concludes that leakage in the Medicare system stems predominantly from non-compliance errors as a result of the complexity of the Medicare system rather than premeditated fraud.
RACGP President Dr Nicole Higgins said that GPs and practice teams should hold their heads high.
"Let me be clear, Dr Philip's review found no evidence to support allegations of Medicare rorting amounting to $8 billion a year, or even a fraction of that amount," she said.
"He concluded that the vast majority of health practitioners, including GPs, are well-meaning and that most Medicare 'leakage' stems from inadvertent errors rather than deliberate fraud. Dr Philip also noted that a large part of the success and efficacy of our health system can be put down to 'altruistic behaviour by health professionals' doing all they can to support their patients. GPs are doing a tremendous job navigating a fiendishly complex Medicare Benefits Schedule, which includes around 6,000 items, and a Health Department which continues to initiate poorly targeted compliance campaigns. As Dr Philip says, there is a lot of fear of the compliance regime, which is actually leading to GPs under-billing Medicare.
"The RACGP agrees that Australia's health funding system is fragmented and disjointed and in critical need of simplification. Estimates of $1.5 billion to $3 billion leaking from the system every year is lost predominantly from honest billing errors rather than premeditated fraud. It's vital that the ABC and Nine newspapers recognise this, because their 'investigation' severely damaged the morale of GPs and practice teams after several trying years managing patients during the pandemic."
The RACGP President said that the RACGP had solutions at the ready.
"We will work with the Government to improve the system. GPs understand that Medicare is taxpayer-funded and needs to have appropriate governance and oversight. The RACGP is focused on solutions and boosting support for general practice care," she said.
"Any suggestion that we're opposed to change is wrong. GPs have no sympathy for anyone who deliberately defrauds Medicare, and supports any actions taken against those who do. What we don't want is the continuation of poorly targeted compliance campaigns that place the onus on GPs to justify their behaviour. It's very positive news that Dr Philip in recommendations 3.6 and 3.7 backs greater educational resources and support to help GPs in their Medicare billing. We have always maintained that an educative rather than punitive approach from the Health Department would be more beneficial.
"We want to see a Medicare system that works for GPs, practice teams and patients, one that is easy to use, and which supports longer consultations so that GPs can take the time to get the bottom of what is going on. So, the ball is in the Government's court, and we look forward to working productively with Health Minister Mark Butler to help fix Medicare. We are not the bad guys; in fact, the report makes it clear that GPs are propping up the entire health system."
Dr Higgins said that GPs deserve respect and understanding.
"GPs are up against it and deserve a break," she said.
"The RACGP strongly rejects the assertion that Medicare is 'loosely scrutinised'. GPs have been subject to numerous targeted compliance letter campaigns, including at the height of the COVID-19 pandemic. The Health Department uses a range of mechanisms to prevent non-compliance – inadvertent or otherwise – including tip-offs, compliance letters, audits, practitioner reviews, and referral to Professional Services Review.
"I have heard claims that the RACGP has failed to acknowledge the vulnerabilities in the system. However, our submission to Dr Philip's review makes it very clear that the complexity of the Medicare Benefits Schedule is contributing to inadvertent billing errors and technical non-compliance. Every single day, GPs are having to decipher complex billing rules whilst trying to care for patients. This is the responsibility of government to fix – not GPs."
The RACGP's Health of the Nation report found almost half of doctors either avoided providing certain services or avoided claiming patient rebates out of fear of Medicare compliance ramifications.
